A Responsibility to Find New Pain-Relief Methods in Midst of the Opioid Crisis

If you’ve ever found yourself in the unenviable position of pointing to a number on one of those pain scales with the cartoon faces, you know that’s not what pain looks like. You know pain looks like landscaping managers, public accountants and mail carriers gritting their teeth and doing exemplary work even when their body doesn’t want to let them.

You probably also know that we — the people of the world and in particular the nations that claim to lead it — need a brand-new approach to relieving human pain. Our existing solutions pack our prisons, sentence nonviolent offenders to life and exacerbate one of the worst and most avoidable tragedies in recent memory.

The State of the Opioid Crisis and What Comes Next

The current Secretary of Health and Human Services, Alex Azar, said in late 2018 that America appeared to be turning a corner on opioid deaths. He cited figures that do, indeed, point to a minor drop-off in opioid-related fatalities. There are reasons to be only cautiously optimistic — such as the small timeframe Azar’s data draws from — but it’s still encouraging to see such signs. The question is, what do we do next?

One of the reasons why opioid deaths may be in decline is that doctors are more reluctant today, with media and regulatory attention, to write prescriptions for opioid-based pain relievers in the numbers previously seen. It’s not debatable that opioids are habit-forming. It’s also well-known that when opioid-based pain relievers aren’t readily available, patients and abusers alike sometimes seek cheaper illicit alternatives that do the job nearly as well, like heroin and fentanyl.

Between 2011 and 2012, we saw another plateau in drug overdose deaths from prescriptions. It was followed swiftly by an explosion in fatalities from fentanyl and other synthetic black-market opioids. We’ve made a small amount of progress by turning the regulatory spotlight on doctors and pharmacies. However, most of the rest of our apparatus for fighting the opioid epidemic doesn’t go nearly far enough.

Public Health Institutions Point the Way Forward

When some U.S. states chose to expand Medicaid and Medicare — social, community-owned health care programs — to cover the cost of drug abuse treatment and prevention, those states saw a corresponding drop in opioid-related deaths.

Nothing about the satisfyingly scientific research done on this subject should take anybody by surprise. Community-owned health programs greatly expand access to life-saving overdose drugs as well as dependency and general health programs for those who need a new way to live a full life even with chronic pain.

Look at it this way: The Affordable Care Act was a public investment in private health insurance companies. It remains as incomplete, selectively helpful and controversial today as the day it became law.

Medicare and Medicaid are public investments in community-owned and government-facilitated health care systems. These programs are still wildly popular and successful, more than half a century after their implementation. They have a vital role to play in helping connect people with pain relief methodologies and medications that work, don’t result in dependency and provide a more confident path forward for those in recovery than any stint in prison ever did.

A New Way Forward Must Include Alternative Medicines

Who lives with chronic pain? As mentioned, anybody, from any walk of life, can find themselves at the mercy of debilitating and recurring pain. Which conditions make this more likely? It’s things like intensive surgeries, nerve damage and a dizzying variety of bodily injuries.

That makes it important for everybody to remember that ill health — and a lifetime of pain afterward — can befall us or somebody we love at any time. The first thing that needs to change about how we manage pain, and health in general, is how we talk about it. If there’s a more social cause than health care, it’d be hard to find.

As a nation that prizes competition and innovation perhaps above all else, we owe it to ourselves to explore every possible avenue when it comes to the cessation of chronic pain and confronting the opioid crisis in a decisive, lasting way. Here are some places to start:

Combined with regular light exercise, meditation apps have shown a great deal of promise in helping chronic pain patients achieve relief throughout their days.

An ever-larger body of research points to THC and other compounds in marijuana as credible pain-relievers and anti-emetics, meaning they could be perfect for those suffering from chronic pain and other complications of cancer treatment.

The opioid dependence that over two million Americans are now facing can partially be attributed to overzealous doctors and hospital staff. It is natural to want to ease somebody’s pain as quickly as possible, but health experts have identified behavior training as another essential component in a holistic answer to pain relief that doesn’t worsen the opioid crisis.

If we can’t find our way, collectively, to more social, community-owned health care institutions, and we don’t wish to make previously illicit substances legal, and we’re skeptical about meditation and yoga, what else is there?

Science and pseudoscience. Relaxation and psychological therapies have shown signs of improving the body’s functionality and even helping ward off pain. Many people swear by acupuncture and aromatherapy for the same reasons. Whether you lean spiritually or prefer a skeptical approach, it’s clear that a decisive end to the opioid crisis requires that we change how we think and talk about pain and how we dispense health care. We must leave no stone unturned in good-faith investigations of alternative treatments that show potential.

What most of our failed pain-management and drug-control strategies so far have in common is that they put capital first. Putting people over profits — be they for pharma or private prisons — is the only thing that will help bring this particular chapter to a close.

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Kate Harveston is originally from Williamsport, PA and holds a bachelor's degree in English. She enjoys writing about health and social justice issues. When she isn't writing, she can usually be found curled up reading dystopian fiction or hiking and searching for inspiration. If you like her writing, follow her blog, So Well, So Woman.

20 Responses

I think that alternative therapies show some promise but they aren’t a complete solution either. I had chronic lower back pain for 20 years. I was one of those people that just gritted my teeth and powered through but I was miserable. Tried almost every therapy out there from opiates to yoga to acupuncture to exercise, with varying levels of success. What helped the most? Finally get an MRI and being diagnosed with osteoarthritis. One pill per day aimed at this has dramatically increased my mobility and quality of life.

Unfortunately back pain especially is an epidemic that has no silver bullet solution.Report

One of the best things doctors can do for pain sufferers is actually listen, investigate, and find out what’s going on. Having people tell you that you’re experiencing something normal or that you’re not really experiencing anything (ie calling you crazy) when it’s obvious that something is very wrong, is terrifying and adds anxiety onto an already difficult situation.

Plus, they can often treat the underlying disease, even if imperfectly, and alleviate some if not most of the suffering without pain meds.Report

Something I’ve been wondering about is why it is that the most effective pain killers are addictive and have recreational potential. Is it just bad luck that the most effective pain killers we’ve found happen to have these properties, or is there some logical reason why we should expect this?Report

As I recall, relief of serious pain requires drugs that bind to opioid receptors in the brain, spinal cord, or peripheral nerves. The most effective pain-relief drugs use the same set of receptors as endorphins, hence the potential for recreational use. Finding alternatives that are both effective and lack recreational potential is an active research area. If someone comes up with one, they’ll get very rich.Report

At least, the opioid receptors seem to be the only avenue of access we’ve found yet where we can deliver a drug.

In general I guess, if a drug is powerful enough to handle real serious pain, it’s probably going to handle serious emotional pain as well as serious physical pain. Which seems likely to mean it’s addictive and has abuse potential.

Maybe instead of / in addition to focusing on “no recreational potential” a useful avenue of research would be things like, lower severity and likelihood of overdose at recreationally realistic doses, less long-term health damage from chronic use, etc.Report

While this is a very nice piece and well-intentioned, as someone who actually has chronic pain from autoimmune disease it sets me on edge when people tell me to meditate and exercise, and/or ask “have you tried cannabis (or turmeric, or flaxseed, or a Thermacare heat wrap, or whatever-it-is)”

I separate the intent of this piece from those who say that as a default position, but if you’re reading this piece I humbly suggest it’s not necessarily a welcome thing to say to your friends/relatives who are in chronic pain.Report

@kristin-devine As a fellow person with autoimmune disease that causes pain, I agree completely.

It would be much more useful to say something like “I’m so sorry you’re going through this. Is there anything useful I can do?”

That said, as such a person, it drives me nuts that the healthcare system is totally on board for throwing as many drugs at me as I could possibly want with merely a few additional hoops … mostly because those drugs *aren’t* that helpful for me except as a failsafe, so I exhibit the opposite of “drug-seeking” behaviors, which is stupid since if I was one of the people they helped more, I’d damn sure be seeking them…. and yet all the stuff I actually find infinitely more helpful, they make onerously difficult to get them to pay for.

I mean, I have the money to pay for it, and I have my lifetime subscription to the one program I’ve found that’s actually lessening my pain by giant leaps and bounds compared to anything else….

But it pisses me off on behalf of other people who have the same issues and might find the same help, and get tons of pressure, economic and otherwise, to stick to drugs.

I find if I look at these “alternative medicine rah rah” pieces as “stop elevating drugs over everything else” instead of going to the place of thinking about all the people who say “have you tried X?”, I find them welcome rather than irritating.

I didn’t take this as an alternative medicine rah-rah piece at all but I did just want to mention that since so many people have said those things to me. I’ve seen enough people on tons of medication that I agree it’s definitely a thing where many people are handed prescriptions they don’t need or even want and totally fine to present alternatives (even if those alternatives didn’t happen to work real well for me personally).

I’ve had a different experience in that I couldn’t get any doctors to believe anything was wrong with me. So it took me years before I got to the point where they were offering me anything other than an eyeroll and anti-depressants. The hoops I’ve had before me involved more “convince me you’re not crazy before I do any investigation” and not “convince me you need/don’t need pain relief”. I haven’t had that situation arise yet and I appreciate hearing your experience, thanks.Report

Weirdly, I was getting “well here are drugs so stop complaining that there’s some underlying problem and something consistently wrong”. So, like, tons of drugs but no interest in solving the problem or identifying the causes. For years. And since most of the drugs weren’t of any help, and the ones that were knocked me over and made me non-functional (hello vicodin, my trusty 4 times a year failsafe), I just kept being in pain the vast majority of the time.

I had chronic pain that was being treated like – and identified as – a series of completely unrelated acute pains. As if I “just happened” to constantly be injured for months because of trivial things.

Looking back, it’s pretty weird… only when I was able to really identify that pattern and talk to my (then-new) GP about that point-blank did anyone start getting on board with the chronic autoimmune illness thing.

Turns out I have a half-dozen of them.

Also turns out (super-weirdly) that the drugs that helped *most* with the pain were classed as anti-depressants *even though I am almost never depressed*. Well, those and the antibiotic that suppressed the immune reaction in my pores so I don’t get giant boils anymore (also not being used as classed, it isn’t killing any flora, just my own immune reaction). Because the body is a strange and wonderful thing and drug classifications are super-narrow.

Sigh.

It’s all so stupid.

Very much agree with your comment, above, that doctors who actually listen and want to understand and solve problems are key to pain management. My then-new GP is now my beloved and trustworthy GP who reads the newest medical research on my conditions regularly and discusses her reading with me. (this only takes about 5 extra minutes in an appointment – more time than that for her reading obviously, but she just sees that as part of being a doctor) She also, non-coincidentally I imagine, has a completely full roster, no ability to see people for urgent care stuff, and no ability to accept new patients. But she’s a damn fine patient advocate / care manager & I see her every 3-4 months to figure out how to keep moving forward. Which is a nice change from seeing her every 3-4 months to figure out how to fracking keep my head above water, but both seem to be rare in the world of pain management…Report

I’m really glad your doctor is good, though it seems like it was an ordeal to finally get one who’d listen to you.

In the last couple months, I’ve had a medium-level health scare. It wasn’t a pain issue, so not directly relevant to the topic at hand (and thankfully, everything *seems* okay now). But it seemed like the doctor listened to me only partially and latched on to a few key words I said without actually listening to other things I said. That’s partly due to my habit of adding the tag line, “then again, it’s possible I’m just making this up.” Anyway, it would have been nice if he had listened to me more.

I also wonder if he would have listened to me as much as he did had I been a woman or not white. I know a woman who a few years ago had some recurring pains and her doctor (also a woman) didn’t seem to treat it as a big deal, but it turned out to be gall stones.Report

It’s NOT due to that habit, Gabriel. They treat everyone like that. I seriously think their policy is to send people away a certain number of times and then if you keep coming back, something may actually be wrong. I’m sorry you had to go through something like that.

But yes it’s way more a problem for women. The doctor left his computer open one day and he put me down as having psych problems and attention seeking. When he finally diagnosed me with something after a year of having me keep diaries and stuff like that, he was so shocked (he hadn’t even bothered to look up my test results) that he couldn’t even hide it.Report

No, and then he was apparently embarrassed or something, because he got up and said “well I’m gonna let you follow up with your eye doctor” and he got up and all but ran out of the room. No referrals, no information, no follow up testing, no treatment plan, nothing. Then when I went back to him after doing my own research to demand a couple of referrals, he was super suspicious of me and eventually asked in a very condescending way “Why do you think you have this disease? Did you look it up on the internet?” He still hadn’t bothered to look up my case history before I went in there, because he’d decided I was crazy I guess and that was all he remembered about me.

But honestly none of that was particularly new, as I’ve been going on for 25 years with these weird symptoms and every doc I’ve seen up until very recently has been some variation on that theme.Report

Ah, I gotcha. I can completely see how that could happen – that rather than them saying “there’s nothing wrong” they might say instead “have some meds”. Same issue, just different solution. No interest in solving the problem or identifying causes. They tried to put me on the anti-depressants too but they made me super dizzy (which I already was, anyway, so I couldn’t function)

Your experience is identical to mine. None of this stuff could possibly be related. In my case it was a supposed series of injuries, rashes, a heart problem, allergies that were nothing like allergies, and “you’re just getting old, it’s perimenopause”. And then the test for it was SO easy – a simple blood test they could have done at any time. It’s inexcusable as widespread as AI diseases are that all women aren’t checked for them every so often.

Same experience as well with the anti-depressant/anti-anxiety medication. I was given Ativan, which helped with this severe dizziness I was experiencing, and so the doc (perhaps understandably) decided “panic attack”. But once they found out I had Meniere’s Disease, well, Ativan is actually the treatment for that. It was coincidental that it helped with my dizziness at the same time.

I used to be one of those people who believed really strongly in “alternative” approaches to medicine, and I still try to keep an open mind about them. I’d like to think I didn’t preach it, but maybe I did.

At any rate, I don’t anymore. I’ve known several people who have pointed out to me how it feels to have people who don’t know what it’s like (which, thankfully and knock on wood, I don’t and haven’t so far) tell them how to deal.Report

Me too – especially exercise. I took having a normal resilient body for granted for sure. I always thought “if I ever get sick the first thing I’ll do is get in fantastic shape and then staying healthy will be my full time job”. I quickly found out that things change when you’re sick and ended up not able to walk for 10 weeks because I overdid it and hurt one of my joints really bad. :/ And that doesn’t even take into account pain, exhaustion, dizziness, nausea, etc that goes along with many illnesses. I realized pretty quick that some of the judgements I’d made about people “not taking care of their health” were completely ridiculous and uncharitable in the extreme.Report

Medicare and Medicaid are public investments in community-owned and government-facilitated health care systems.

1. Medicare and Medicaid are government-run insurance programs. In no way shape or form can anyone describe them as “investments” based on the mainstream definition of the term.

2. Aside from the VA, the U.S. government neither owns nor operates health systems. Health systems describe healthcare providers, usually those own and operate acute care hospitals.

3. “Community-owned” is socialist nonsense. This is the kind of language trickery that was all over Matt Bruenig’s rainbows and unicorns attempt to make a case for a U.S. “social wealth” fund, which in reality is really a sovereign wealth fund since the assets are technically owned by the sovereign government. While the “community” benefits, the idea that the “community” shares any of the rights/privileges/responsibilities associated with ownership requires a more vivid imagination than I have.Report

Religious Institutions. Religious institutions may resume services subject to the following conditions, which apply to churches, synagogues, temples, mosques, interfaith centers, and any other space, including rented space, where religious or faith gatherings are held: 1. Indoor religious gatherings are limited to no more than ten people. 2. Outdoor religious gatherings of up to 250 people are allowed. Outdoor services may be held on any outdoor space the religious institution owns, rents, or reserves for use. 3. All attendees at either indoor or outdoor services must maintain appropriate social distancing of six feet and wear face masks or facial coverings at all times. 4. There shall be no consumption of food or beverage of any kind before, during, or after religious services, including food or beverage that would typically be consumed as part of a religious service. 5. Collection plates or receptacles may not be passed to or between attendees. 6. There should be no hand shaking or other physical contact between congregants before, during, or after religious services. Attendees shall not congregate with other attendees on the property where religious services are being held before or after services. Family members or those who live in the same household or who attend a service together in the same vehicle may be closer than six feet apart but shall remain at least six feet apart from any other persons or family groups. 7. Singing is permitted, but not recommended. If singing takes place, only the choir or religious leaders may sing. Any person singing without a mask or facial covering must maintain a 12-foot distance from other persons, including religious leaders, other singers, or the congregation. 8. Outdoor or drive-in services may be conducted with attendees remaining in their vehicles. If utilizing parking lots for either holding for religious services or for parking for services held elsewhere on the premises, religious institutions shall ensure there is adequate parking available. 9. All high touch areas, (including benches, chairs, etc.) must be cleaned and decontaminated after every service. 10. Religious institutions are encouraged to follow the guidelines issued by Governor Hogan.

“There shall be no consumption of food or beverage of any kind before, during, or after religious services, including food or beverage that would typically be consumed as part of a religious service,” the order says in a section delineating norms and restrictions on religious services.

The consumption of the consecrated species at Mass, at least by the celebrant, is an integral part of the Eucharistic rite. Rules prohibiting even the celebrating priest from receiving the Eucharist would ban the licit celebration of Mass by any priest.

CNA asked the Howard County public affairs office to comment on how the rule aligns with First Amendment religious freedom and free exercise rights.

Howard County spokesman Scott Peterson told CNA in a statement that "Howard County has not fully implemented Phase 1 of Reopening. We continue to do an incremental rollout based on health and safety guidelines, analysis of data and metrics specific to Howard County and in consultation with our local Health Department."

"With this said," Peterson added, "we continue to get stakeholder feedback in order to fully reopen to Phase 1."

The executive order also limits attendance at indoor worship spaces to 10 people or fewer, limits outdoor services to 250 socially-distanced people wearing masks, forbids the passing of collection plates, and bans handshakes and physical contact between worshippers.

In contrast to the 10-person limit for churches, establishments listed in the order that do not host religious services are permitted to operate at 50% capacity.

In the early days of the Coronavirus epidemic, there were hopes that the disease could be treated with a compound called hydroxychloroquine (HCQ). HCQ is a long-established inexpensive medicine that is widely used to treat malaria. It also has uses for treating rheumatoid arthritis and lupus. There had been some indications that HCQ could treat SARS virus infections by attacking the spike proteins that coronaviruses use to latch onto cells and inject their genetic material. Initial small-scale studies of the drug on COVID-19 patients indicated some positive effect (in combination with the antibiotic azithromycin). President Trump, in March, promoted HCQ as a game-changer and is apparently taking it as a prophylaxis after potentially being exposed by White House staff.

Initial claims of the efficacy of this therapy were a perfect illustration of why we base decisions on scientific studies and not anecdotes. By late March, Twitter was filled with stories of "my cousin's mother's former roommate was on death's door and took this therapy and miraculously recovered". But such stories, even assuming they are true, mean nothing. With COVID-19, we know that seriously ill people reach an inflection point where they either recover or die. If they died while taking the HCQ regimen, we don't hear from them because...they died. And if they recover without taking it, we don't hear from them because...they didn't take it. Our simian brains have evolved to think that correlation is causation. But it isn't. If I sacrificed a goat in every COVID-19 patient's room, some of them would recover just by chance. That doesn't mean we should start a massive holocaust of caprines.

However, even putting aside anecdotes, there were good reasons to believe the HCQ regimen might work. And given the seriousness of this disease and the desperation of those trying to save lives, it's understandable that doctors began using it for critically ill patients and scientists began researching its efficacy.

Why Trump became fixated on it is equally understandable. Trump has been looking for a quick fix to this crisis since Day One. Denial failed. Closing off (some) travel to China failed. A vaccine is months if not years away. So HCQ offered him what he wanted -- a way to fix this problem without the hard work, tough choices and sacrifice of stay-at-home orders, masks, isolation and quarantine. So eager were they to adopt the quick fix, the Administration made plans to distribute millions of doses of this unproven drug in lieu of taking more concrete steps to address the crisis.[efn_note]Although the claim that Trump stands to profit off HCQ sales does not appear to hold much water.[/efn_note]

This is also why certain fringe corners of the internet became fixated on it. There has arisen a subset of the COVID Truthers that I'm calling HCQ Truthers: people who believe that HCQ isn't just something that may save some lives but is, in fact, a miracle cure that it's only being held back so that...well, take your pick. So that Democrats can wreck the economy. So that Bill Gates can inject us with tracking devices. So that we can clear off the Social Security rolls. And this isn't just a US phenomenon nor is it all about Trump. Overseas friends tell me that COVID trutherism in general and HCQ trutherism in particular have arisen all over the Western World.

It's no accident that the HCQ Truthers seem to share a great deal of headspace with the anti-Vaxxers. It fills the same needs

In both cases, the idea was started by flawed studies. The initial studies out of China and France that indicated HCQ worked were heavily criticized for methodological errors (although note that neither claimed it was a miracle cure). Since then, larger studies have shown no effect.

HCQ trutherism offers an explanation for tragedy beyond the random cruelty of nature. Just as anti-vaxxers don't want to believe that sometimes autism just happens, HCQ Truthers don't want to believe that sometimes nature just releases awful epidemics on us. It's more comforting, in some ways, to think that bad happenings are all part of a plan by shadowy forces.

There is, however, another crazy side that doesn't get as much attention because their crazy is a bit more subtle. These are the people who have decided that, since Trump is touting the HCQ treatment, it must not work. It can not work. It can not be allowed to work. There is an undisguised glee when studies show that HCQ does not work and a willingness to blame HCQ shortages on Trump and only Trump.[efn_note]Not to mention the odd fish tank cleaner poisoning that has nothing to do with him.[/efn_note]

In between the two camps are everyone else: scientists, doctors and ordinary folk who just want to know whether this thing works or not, politics and conspiracy theories be damned. Well, last week, we got a big indication that it does not. A massive study out of the Lancet concluded that the HCQ regimen has no measurable positive effect. In fact, death rates were higher for those who took the regimen, likely due to heart arrhythmias induced by the drug.

So is the debate over? Can we move on from HCQ? Not quite.

First of all, the study is a retrospective study, looking backward at nearly 100,000 cases over the last four months. That's a massive sample that allows one to correct for potential confounding factors. But it's not a double-blind trial, so there may be certain biases that can not be avoided. In response to the publication, a group doing a controlled study unblinded some of their data (that is, they let an independent group look up who was getting the actual HCQ and who was getting a placebo). It did not show enough of a safety concern to warrant ending the study.

It's also worth noting that because this is an unproven therapy, it is usually being used on only the sickest patients (the odd President of the United States aside). It's possible earlier use of the drug, when the body is not already at war with itself, could help.

With those caveats in mind, however, this study at least makes it clear that HCQ is not the miracle cure some fringe corners of the internet are pretending it is. And it should make doctors hesitant in giving to people who already have heart issues.

As you can imagine, this has only fed the twin camps of derangement. The truther arguments tend to fall into the usual holes that truther theories do:

"How can this be a four-month study when we only learned about COVID in January!" The HCQ protocol started being used almost immediately because of previous research on coronaviruses.

"How come all of the sudden this safe medicine that people use all the time is dangerous?!" The side effects of HCQ have been well known for years and have always required consideration and management. They may be showing up more strongly here because it is being given to patients whose bodies are already under extreme stress. Also, azithromycin may amplify some of those side effects.

"They just hate Trump." Not everything is about Donald Trump. If it turned out that kissing Donald Trump's giant orange backside cured COVID, scientists would be the first ones telling people to line up and use chapstick.

The other camp's response has ranged from undisguised glee -- that is, joy at the idea that we won't be saving lives cheaply -- to bizarre claims that Trump should be charged with crimes for touting this unproven therapy.

(A perfect illustration of the dementia: former FDA Head Scott Gottlieb -- who has been a Godsend for objective analysis during the pandemic -- tweeted out the results of the RECOVERY unblinding yesterday morning and noted that it showed no increased safety risk. He was immediately dogpiled by one side insisting he was trying to conceal the miracle cure of HCQ and the other insisting he is a Trumpist doing the Orange Man's dirty work.)

In the end, the lunatics do not matter. Whether HCQ works or not, whether it is used or not, will be mostly determined by doctors and will mostly be based on the evidence we have in front of us. If HCQ fails -- and it's not looking good -- my only response will be massive disappointment. Had HCQ worked, it would have been a gift from the heavens. It is a well-known, well-studied drug that can be manufactured cheaply in bulk. Had it worked, we could have saved thousands of lives, prevented hundreds of thousands of long-term injuries and saved trillions of dollars. That it doesn't appear to work -- certainly not miraculously -- is not entirely unexpected but is also a tragedy.

{C1} The Christian Science Monitor looks at 1918 and how sports handled that pandemic, and the role it played in giving rise to college football.

"That's really what started the big boom of college football in the 1920s," said Jeremy Swick, historian at the College Football Hall of Fame. "People were ready. They were back from war. They wanted to play football again. There weren't as many restrictions about going out. You could enroll back in school pretty easily. You see a great level of talent come back into the atmosphere. There's new money. It started to get to the roar of the Roaring '20s and that's when you see the stadiums arm race. Who can build the biggest and baddest stadium?"

{C2} During times of rapid change, social science is supposed to be able to help lead the way or at least decipher what is going on. Or maybe not...

But while Willer, Van Bavel, and their colleagues were putting together their paper, another team of researchers put together their own, entirely opposite, call to arms: a plea, in the face of an avalanche of behavioral science research on COVID-19, for psychology researchers to have some humility. This paper—currently published online in draft format and seeding avid debates on social media—argues that much of psychological research is nowhere near the point of being ready to help in a crisis. Instead, it sketches out an “evidence readiness” framework to help people determine when the field will be.

{C3} There is a related story about AI - which is predisposed towards tracking slow change over time - is having trouble keeping up.

{C4} The Covid-19 does not bode well for higher education is not news. They may have a lot of difficulty opening up (and maybe shouldn't). An added wrinkle is kids taking a gap year, which is potentially a problem because those most able to pay may be least likely to attend.

{C5} People who can see the faults with abstinence only education fail to see how that logic (We shouldn't give guidance to people doing things we would rather they not do in the first place). Emily Oster argues that the extreme message of public health advocates to Just Stay Home is counterproductive.

When people are advised that one very difficult behavior is safe, and (implicitly or not) that everything else is risky, they may crack under the pressure, or throw up their hands. That is, if people think all activities (other than staying home) are equally risky, they figure they might as well do those that are more fun. If taking a walk at a six-foot distance from a friend puts me at very high risk, why not just have that friend and a bunch of others over for a barbecue? It’s more fun. This is an exaggeration, of course, but different activities carry very different risks, and conscientious civic leaders should actively help people choose among them.

{C6} A look at what canceling the football season will do to the little guys - non-power schools. Ironically, they may sustain less damage due to fewer financial obligations relying on the money that won't be coming in. Be that as it may, Fordham has disestablished its baseball program.

{C7} Bans on evictions and rental spikes could have the main effect of simply pushing out small investors, rather than protecting renters. In a more good-faith economy this would be less of an issue because landlords would work with tenants. Which some are, though I don't have too much faith about it being widespread.

{C8} Three cheers for Nick Saban. Football coaches are cultural leaders of a sort. One is about to become a senator in Alabama, even. What they do matters.

The American college experience for better or for worse revolves around the residency factor. We have turned college into a relatively safe place for young adults to the test the limits of freedom without suffering too many consequences. Better to miss a day of classes because you drank too much than to miss a day of an apprenticeship or job and get fired. College was cut short this semester because of COVID and colleges are freaking out about whether they can open up dorms in the fall. The dorms are big money makers and it is hard to justify huge tuition bucks for zoom lectures even for elite universities. Maybe especially for them. California State University announced that Fall 2020 is going to be largely online. My undergrad alma mater sent out an e-mail blast announcing their plan to reopen in the fall with "mostly" in person classes. The President admitted that the plan was a work in progress but it strikes me as a combination of common sense and extreme wishful thinking. The plan may include:

1. Staggered drop-off days to limit density as we return.

This sounds reasonable but only in a temporary way because eventually everyone will be back on campus, living in dorm rooms together, needing to use communal bathrooms and showers.

2. Students would be tested for COVID-19 on campus at least twice in the first 14 days.

There is nothing wrong with this as long as the testing is available. Our capacity for testing so far in this country has not been great.

3. Anyone experiencing symptoms would be tested immediately. Students who test positive would be cared for in a separate dormitory area where food would be brought to the room and where the student could still access classes remotely.

Nothing wrong here. Outbreaks of certain diseases are not unknown in the college setting. During my senior year, there was an outbreak of a rather nasty strain of gastroenteritis. Other universities have experienced meningitis outbreaks.

4. All students would take their temperature and report symptoms daily.

This one is also reasonable but is going to involve spying on students and coming up with a punishment mechanism. How will they make sure students are not lying?

5. We would also require that socializing be kept to a minimum in the beginning, with proper PPE (masks) and social distancing. As time went on, we would seek to open up more, and students could socialize and eat together in small groups.

I have no idea how they tend for this to happen and it sets of all my lawyer bells for carefully crafted language that attempts to answer a concern or question but also admits "we got nothing." Maybe today's students are more somber and sincere but you are going to have around 500 eighteen year olds who are away from their parents for the first time and another 1500 nineteen to twenty-one year olds who had their semester rudely interrupted and might now be reunited with boyfriends and girlfriends. Are they going to assign eating times for the dining hall and put up solo eating cubicles that get wiped down and disinfected after each use? Assign times to use laundry facilities in each dorm? Cancel the clubs? Cancel performances by the theatre, dance, and music departments?

I am sympathetic to my alma I love it but and realize that a lot of colleges and universities would take a real hit financially without residency. This includes universities with reasonable to very large endowments. Only the ones with hedge fund size endowments would not suffer but the last part of the plain sounds not fully thought out yet even if my college's current President admitted: "Life on campus will not look the same as it did pre-pandemic" The only way i see number 5 working is if requiring is read as "requiring."

Seems that the theory that Covid-19 can be spread by asymptomatic people has very shaky evidence in support of it. Turns out the case this assumption was made from was based on a single woman who infected 4 others. Researchers talked to the 4 patients, and they all said the patient 0 did not appear ill, but they could not speak to patient 0 at the time.

So they finally got to talk to her, and she said she was feeling ill, but powered through with the aid of modern pharmaceuticals.

Ten Second News

Today we couldn’t be happier to announce that Vox Media and New York Media are merging to create the leading independent modern media company. Our combined business will be called Vox Media and will serve hundreds of millions of audience members wherever they prefer to enjoy our work.

In a nation in turmoil, it's nice to have even a small bit of good news:

Representative Steve King of Iowa, the nine-term Republican with a history of racist comments who only recently became a party pariah, lost his bid for renomination early Wednesday, one of the biggest defeats of the 2020 primary season in any state.

In a five-way primary, Mr. King was defeated by Randy Feenstra, a state senator, who had the backing of mainstream state and national Republicans who found Mr. King an embarrassment and, crucially, a threat to a safe Republican seat if he were on the ballot in November.

The defeat was most likely the final political blow to one of the nation’s most divisive elected officials, whose insults of undocumented immigrants foretold the messaging of President Trump, and whose flirtations with extremism led him far from rural Iowa, to meetings with anti-Muslim crusaders in Europe and an endorsement of a Toronto mayoral candidate with neo-Nazi ties.

King, you may remember, was stripped of his committee assignments last year when he defended white supremacism. Two years ago, he almost lost his Congressional seat in the general. That is, a seat that Republicans have held since 1986, usually win by double digits and a district Trump carried by a whopping 27 points almost came within a point or two of voting in a Democrat. That's how repulsive King had gotten.

Good riddance to bad rubbish. Enjoy retirement, Congressman. Oops. Sorry. In January, it will be former Congressman.

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From the Daily Mail: Deadliest city in America plans to disband its entire police force and fire 270 cops to deal with budget crunch

The deadliest city in America is disbanding its entire police force and firing 270 cops in an effort to deal with a massive budget crunch.

...

The police union says the force, which will not be unionized, is simply a union-busting move that is meant to get out of contracts with current employees. Any city officers that are hired to the county force will lose the benefits they had on the unionized force.

Oak Park police say they are investigating “suspicious circumstances” after two attorneys — including one who served as a hearing officer in several high-profile Chicago police misconduct cases — were found dead in their home in the western suburb Monday night.

Officers were called about 7:30 p.m. for a well-being check inside a home in the 500 block of Fair Oaks Avenue, near Chicago Avenue, and found the couple dead inside, Oak Park spokesman David Powers said in an emailed statement. Authorities later identified them as Thomas E. Johnson, 69, and Leslie Ann Jones, 67, husband and wife attorneys who worked in Chicago.

The preliminary report from an independent autopsy ordered by George Floyd's family says the 46 year old man's death was "caused by asphyxia due to neck and back compression that led to a lack of blood flow to the brain".

The independent examiners found that weight on the back, handcuffs and positioning were contributory factors because they impaired the ability of Floyd's diaphragm to function, according to the report.

Dr. Michael Baden and the University of Michigan Medical School's director of autopsy and forensic services, Dr. Allecia Wilson, handled the examination, according to family attorney Ben Crump.

Baden, who was New York's medical examiner in 1978 and 1979, had previously performed independent autopsies on Eric Garner, who was killed by a police officer in Staten Island, New York, in 2014 and Michael Brown, who was shot by officers in Ferguson, Missouri, that same year.

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Oddly, the video was dropped by an attorney friend the men, because he thought it would exonerate them. He assumed when people saw Aubrey turn and try to defend himself, everyone would see what they did: a dangerous animal needing to be put down.